Free school meals as an approach to reduce health inequalities among 10-12-year-old Norwegian children

BackgroundChildren spend a considerable amount of time at school and consume at least one meal/day. This study aimed to investigate if a free, healthy school meal every day for one school year was associated with children's intake of healthy foods at school, weight status and moderating effects of socio-economic status.MethodsA non-randomized study design with an intervention and a control group was used to measure change in children's dietary habits at lunchtime. In total, 164 children participated; 55 in the intervention group and 109 in the control group (baseline). Intervention-children were served a free, healthy school meal every school day for one year. Participating children completed a food frequency questionnaire at baseline, at five months follow-up and after one year. Children's anthropometrics were measured at all three timepoints. Intervention effects on children's Healthy food score, BMI z-scores, and waist circumference were examined by conducting a Repeated Measures Multivariate ANOVA. Moderating effects of children's gender and parental socio-economic status were investigated for each outcome.ResultsA significant intervention effect on children's outcomes (multivariate) between baseline and after one year (F=2.409, p<0.001), and between follow-up 1 at five months and after one year (F=8.209, p<0.001) compared to the control group was found. The Univariate analyses showed a greater increase in the Healthy food score of the intervention group between baseline and follow-up 1 (F=4.184, p=0.043) and follow-up 2 (F=10.941, p=0.001) compared to the control group. The intervention-children had a significant increase in BMI z-scores between baseline and follow-up 2 (F=10.007, p=0,002) and between follow-up 1 and 2 (F=22.245, p<0.001) compared to a decrease in the control-children. The intervention-children with lower socio-economic status had a significantly higher increase in Healthy food score between baseline and follow-up 2 than the control-children with lower socio-economic status (difference of 2.8 versus 0.94), but not among children with higher socio-economic status.ConclusionsServing a free school meal for one year increased children's intake of healthy foods, especially among children with lower socio-economic status. This study may contribute to promoting healthy eating and suggests a way forward to reduce health inequalities among school children.Trial registrationISRCTN61703361. Date of registration: December 3rd, 2018. Retrospectively registered

Can Parenting Practices Moderate the Relationship between Reward Sensitivity and Adolescents’ Consumption of Snacks and Sugar-Sweetened Beverages?

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A reinforcement sensitivity perspective on adolescents' susceptibility to the influence of soap opera viewing on alcohol attitudes

Previous research found support for an association between exposure to alcohol-related media content and alcohol attitudes, intentions and behavior. Nevertheless, research on what makes young people susceptible to the occurrence of this relationship is scarce. The current study examined the behavioral activation (BAS) and inhibition system (BIS) as moderators of the relationship between soap opera viewing and alcohol attitudes. A cross-sectional survey was carried out among a sample of 922 adolescents (M-age=14.96years, SD=.85, 56% girls). Regression analyses showed no association between total television viewing and alcohol attitudes, but did confirm that soap opera viewing is associated with positive attitudes towards alcohol use. Moderation analyses indicated that BAS did not moderate this relationship, while BIS did; the relationship between soap opera viewing and positive attitudes toward alcohol was only significant for adolescents with a low BIS-profile. These results provide support for the premise that an elevated BIS protects adolescents from the effect of soap opera viewing frequency on their alcohol attitudes

Disposition-content congruency in adolescents' alcohol-related social media (self-) effects : the role of the five-factor model

Objective: Accumulating evidence indicates that social networking sites play an increasingly important role in young people's drinking behavior. The present study adds to this research by assessing the conditionality of the relationships between exposure to and self-sharing of alcohol-related content on social media and adolescents' drinking behavior. Specifically, the moderating role of the five-factor model of personality is determined. Method: A cross-sectional survey study was conducted among 866 mid-adolescents (Msubsample = 14.85 years, SD = 0.71, 57.5% girls). Polynomial regression analysis with response surface modeling was used to test the interactions. Results: Exposure, but not self-sharing, was directly associated with more alcohol consumption. However, it appeared that the act of sharing was more important than the frequency of sharing. Next, the relationship between exposure and consumption was not found to be moderated by personality. In contrast, there were significant linear and nonlinear interactions between self-sharing and all five personality traits. Individuals who are predisposed to engage in more alcohol consumption experience a stronger association between self-sharing and their drinking behavior. Conclusions: Social media can play a role in adolescents' drinking behavior, but this role is partially dependent on temperamental predispositions

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour : a systematic review

Background: Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. Methods: Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers. Results: Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics, and three of them demonstrated that higher app usage was associated with improved health outcomes. Conclusions: This review provided modest evidence that app-based interventions to improve diet, physical activity and sedentary behaviours can be effective. Multi-component interventions appear to be more effective than standalone app interventions, however, this remains to be confirmed in controlled trials. Future research is needed on the optimal number and combination of app features, behaviour change techniques, and level of participant contact needed to maximise user engagement and intervention efficacy

Effect of a free healthy school meal on fruit, vegetables and unhealthy snacks intake in Norwegian 10-to 12-year-old children

Background Norwegian children have a lower intake of fruit, vegetables, and a higher intake of unhealthy snacks compared to dietary guidelines. Such dietary inadequacies may be detrimental for their current and future health. Schools are favorable settings to establish healthy eating practices. Still, no school meal arrangement is provided in Norway, and most children typically bring packed lunches from home. The aim of this study was to investigate whether serving a free healthy school meal for one year resulted in a higher intake of fruit and vegetables and a lower intake of unhealthy snacks in total among 10-12-year-olds in Norway.MethodsThe School Meal Project in Southern Norway was a non-randomized trial in two elementary schools in rural areas in the school year 2014/2015. The study sample consisted of 10- to 12-year-old children; an intervention group (N=55) and a control group (N=109) resulting in a total of 164 school children at baseline. A food frequency questionnaire was completed by the children at baseline, at five months follow-up and after one year to assess fruit, vegetable, and snacks intake. Multiple linear regression analyses were performed to assess intervention effects on overall intake of fruit and vegetables and unhealthy snacks.ResultsServing of a free healthy school meal for one year was associated with a higher weekly intake of vegetables on sandwiches in the intervention group compared to the control group, adjusted for baseline intake (B: 1.11 (95% CI: .38, 1.85)) at the end of the intervention. No other significant intervention effects were found for the remaining fruit and vegetables measures. Serving of a free healthy school meal was not associated with a lower weekly intake of unhealthy snacks (i.e. potato chips, candy, sugar sweetened beverages) in the intervention group compared to the control group.ConclusionsA free healthy school meal was associated with a higher weekly intake of vegetables on sandwiches but did not significantly change any other investigated dietary behaviors. However, given the inadequate intake of vegetables among children and that even moderate improvements have public health relevance, a free healthy school meal for all school children could be beneficial.Trial registrationISRCTN61703361.Date of registration: December 3rd, 2018.Retrospectively registered

Qualitative Evaluation of the STOEMP Network in Ghent : An Intersectoral Approach to Make Healthy and Sustainable Food Available to All

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Associations between parental food choice motives, health-promoting feeding practices, and infants’ fruit and vegetable intakes : the Food4toddlers study

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Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet : Randomized Controlled Trial

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